The United States has moved quickly in the past few years toward acceptance of the transgender community, and embraced a more inclusive approach when it comes to health care.
Employers are increasingly offering services in their health plans that are crucial to transgender people, including hormone therapy and sex change operations.
Gender-confirmation surgery has long been cost-prohibitive. Not many hospitals have offered the service, and until recently, it was rare for an insurer to provide coverage for such a procedure, since it was not considered a medical operation. In the past, sex-change procedures were largely the realm of plastic surgeons.
According to the Wall Street Journal, the Centers for Medicare and Medicaid Services started to allow coverage of transgender-related surgeries in 2014. As it stands, Medicaid programs in 12 states and D.C. cover care related to transitioning. Other commercial insurers have also begun providing coverage for these procedures, such as Aetna, Amerigroup, Anthem, Cigna, Emblem Health, UnitedHealthcare, and UniCare, just to name a few.
But as attitudes toward gender identity change, more hospitals are offering surgery for transgender patients while more insurers are offering coverage for operations.
Whether as a result of the increasing availability of surgeries or because more transgender people are coming out in the wake of a cultural shift in their favor, demand for transgender operations is rising significantly, say doctors. Two hundred people are on the waiting list for vaginoplasty at Boston Medical Center, which only began offering the procedure earlier this month, hospital officials told The Wall Street Journal.
Still, change may not come quite as easily in the public sector.
While the Obama administration has authorized coverage of transgender services for Medicare and Medicaid, only 12 states and the District of Columbia have opted to include gender-confirmation operations in their Medicaid plans. There will no doubt be plenty of resistance in GOP-run states to embrace such changes.
Transgender prisoners present another sensitive area in the debate over the use of public funds for certain medical services.
The issue was broached in the Netflix show, "Orange is the New Black," in which a transgender character campaigns for access to hormone therapy. In the real world, the issue was demonstrated recently in the case of Chelsea Manning, the former soldier imprisoned for leaking classified information to WikiLeaks. The Army recently agreed to pay for her to undergo surgery which had been recommended by her psychologist in the wake of a lawsuit by the ACLU.
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